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4 reasons insurers should always cover treatment for autism

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A total of 37 states and the District of Columbia have laws related to autism and insurance coverage. And recently, the Center for Medicare & Medicaid Services (CMS) announced that in many of these states, Medicaid, Medicare, the federal Children’s Health Insurance Programs (CHIP), and all commercial carriers must provide autism-spectrum coverage. 

See also: Calif. health plans must provide behavioral analysis coverage.

Cue a round of applause.

This recent change is an incredible victory for children and adults with autism, and it comes at the right time: The Centers for Disease Control and Prevention just released a report that showed a 30 percent increase in the number of children with autism within the last two years. This means that, in the United States, one in 68 children needs treatment for autism.

The ramifications of not providing coverage for autism treatments

With autism on the rise, it’s crucial that insurance companies take the initiative to cover treatment options.

Autism treatment options, including applied behavior analysis (ABA), occupational therapy services, and social skills groups, have helped thousands of children and adults living with autism lead more normal lives. But if that’s the case, then the question is: Why did it take so long for insurers to cover autism care?

See also: Applied Behavioral Analysis Suit Wins Class-Action Status.

Up until now, insurance plans haven’t wanted to cover autism treatments because there’s no way to control or predict the cost of these services (ABA costs an average of $50,000 per year, for example). What’s more, autism-spectrum disorders cover a range of impairments, from mild to profound.

However, a lack of coverage is simply not the answer. In fact, not having covered benefits actually prevents many autistic children from becoming self-sufficient, productive adults.

See also: Autism mandate has ‘minimal’ effect in Missouri.

And if families can’t afford a supplemental policy, their loved ones often go without treatment. This is very unfortunate, as ABA has been shown to be effective in mainstreaming many children with autistic-spectrum disorders.

Why autism insurance coverage is vital

As insurers, it’s crucial to fully understand why autism coverage is important and the mutual benefits it has for both insurance companies and families. Here are four reasons insurance coverage is vital for everyone involved:

  1. Mainstreaming students helps curb autism and saves everyone money. Early intervention with students can help level the playing field later on. Mainstreamed students go on to hold jobs and raise families. Providing coverage for early intervention will allow these students to become productive members of society, saving millions of dollars in the future.
  2. Insurers collect more premiums, and families get better coverage. Many families purchase family insurance plans. But by providing coverage for autism-spectrum disorders, insurers will be able to collect the premiums on that coverage rather than have families pay premiums to other insurers.
  3. Parents and caretakers will be healthier. It’s well-known that insurance providers appreciate healthy clients. By providing coverage for autism-spectrum disorders, the parents and caretakers of individuals with autism will have more time and energy to practice preventive health measures for themselves. And without the stress of worrying about their family members’ care, they will experience added health benefits beyond regular checkups and screenings.
  4. Insurance companies will gain a broader client base. Now that autism-spectrum coverage is a requirement in many states, insurance companies have a great opportunity to gain clients. They can enhance their reputations by being ahead of the curve on autism coverage. Insurance companies with the best reputation will attract the most clients, and companies with a large number of clients have the opportunity to become very powerful and influential within the insurance field.

Autistic-spectrum coverage can make a truly remarkable difference in people’s lives.

For example, a few years ago, I worked with a 3-year-old boy who was diagnosed with autism. Insurance-covered ABA was made possible by a team of three ABA therapists, a coordinator, and a case manager.

After two years of care, the parents and treatment team decided that a “summer camp” experience would be beneficial for getting the boy classroom-ready. And at the end of the two-month summer camp, the parents and treatment team felt that the boy would be classroom-ready by age 7 and mainstreamed by age 8 or 9. Had this family not received coverage, the boy still wouldn’t be able to attend school.

Seeing victories like the one above is a great reminder that, at the end of the day, the purpose of insurance companies is to enable people to lead happier and healthier lives. With autism care coverage, the one in 68 children in the U.S. with autism will have access to the care they need to grow into healthy kids, teens, and adults.


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